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Original Research: COPD |

Airway Count and Emphysema Assessed by Chest CT Imaging Predicts Clinical Outcome in Smokers

Alejandro A. Diaz, MD; Clarissa Valim, MD, PhD; Tsuneo Yamashiro, MD; Raúl San José Estépar, PhD; James C. Ross, MS; Shin Matsuoka, MD, PhD; Brian Bartholmai, MD; Hiroto Hatabu, MD, PhD; Edwin K. Silverman, MD, PhD; George R. Washko, MD
Author and Funding Information

From the Pulmonary and Critical Care Medicine Division (Drs Diaz, Silverman, and Washko), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; the Department of Radiology (Drs Yamashiro and Hatabu) and the Surgical Planning Laboratory (Dr San José Estépar and Mr Ross), Laboratory of Mathematics in Imaging, Department of Radiology; and the Channing Laboratory (Dr Silverman), Brigham and Women’s Hospital, Boston, MA; and the Department of Immunology and Infectious Disease and the Department of Biostatistics (Dr Valim), Harvard School of Public Health, Boston, MA; the Department of Radiology (Dr Matsuoka), St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan; the Department of Radiology (Dr Bartholmai), Mayo Clinic, Rochester, MI; and the Department of Pulmonary Diseases (Dr Diaz), Pontificia Universidad Católica de Chile, Santiago, Chile.

Correspondence to: Alejandro A. Diaz, MD, Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115; e-mail: adiaz6@Partners.org


Funding/Support: This work was supported by the National Institutes of Health [Grants K23HL089353-01A1 and U01089856] and by a grant from the Parker B. Francis Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(4):880-887. doi:10.1378/chest.10-0542
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Background:  Recently, it has been shown that emphysematous destruction of the lung is associated with a decrease in the total number of terminal bronchioles. It is unknown whether a similar decrease is visible in the more proximal airways. We aimed to assess the relationships between proximal airway count, CT imaging measures of emphysema, and clinical prognostic factors in smokers, and to determine whether airway count predicts the BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index.

Methods:  In 50 smokers, emphysema was measured on CT scans and airway branches from the third to eighth generations of the right upper lobe apical bronchus were counted manually. The sum of airway branches from the sixth to eighth generations represented the total airway count (TAC). For each subject, the BODE index was determined. We used logistic regression to assess the ability of TAC to predict a high BODE index (≥ 7 points).

Results:  TAC was inversely associated with emphysema (r = −0.54, P < .0001). TAC correlated with the modified Medical Research Council dyspnea score (r = −0.42, P = .004), FEV1% predicted (r = 0.52, P = .0003), 6-min walk distance (r = 0.36, P = .012), and BODE index (r = −0.55, P < .0001). The C-statistics, which correspond to the area under the receiver operating characteristic curve, for the ability of TAC alone and TAC, emphysema, and age to predict a high BODE index were 0.84 and 0.92, respectively.

Conclusions:  TAC is lower in subjects with greater emphysematous destruction and is a predictor of a high BODE index. These results suggest that CT imaging-based TAC may be a unique COPD-related phenotype in smokers.

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